AB0182 THE PROFILE OF POOR PROGNOSTIC FACTORS BASED ON EULAR RECOMMENDATIONS IN CHINESE RA PATIENTS: A SINGLE-CENTER OBSERVATIONAL STUDY
Authors: Y. Gui, Z. Zhang, J. Zhao
Journal: Annals of the Rheumatic Diseases (2022)

Background Despite the constant updating of rheumatoid arthritis (RA) treatment strategies, whether poor prognostic factors (PPFs) can guide RA treatment is still controversial. There are limited data about the presence of PPFs in Chinese RA patients. Objectives To describe the profile of PPFs based on European League Against Rheumatism (EULAR) recommendations in Chinese RA patients, and explore the significance of these factors in adjusting treatment therapy. Methods In this real-world study, RA patients were enrolled from 2012 to 2020. The baseline characteristics and prognostic factors based on EULAR recommendations include acute-phase reactant levels, rheumatoid factor (RF), anti-cyclic citrullinate peptide (anti-CCP antibody), swollen joint counts (SJC), early bone erosions, and responses to conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD) at month 3 or month 6 were collected. Disease activity was assessed by disease activity score of 28 joints-erythrocyte sedimentation rate (DAS28-ESR), DAS28-C-reactive protein (DAS28-CRP), simple disease activity index (SDAI), and clinical disease activity index (CDAI). The association of different factors was represented by a Venn diagram. The number of patients presenting with different combinations of prognostic factors was graphically displayed by UpSetR. Correlation between binary variables was analyzed by the Chi-square test. Results 1252 registered RA patients were enrolled. 901/1252 (72.0%) patients had elevated ESR or CRP and 1027/1164 (88.2%) patients had positive RF or anti-CCP antibody. 397/1252 (31.7%) patients had ors was graphicas. 166/444 (37.0%) patients had early bone erosions, which usually coexisted with other PPFs. 394 (34.4%) of the 1105 patients who received csDMARD therapy as prescribed had persistent moderate or high disease activity (MDA/HDA). Failure of two or more csDMARDs was found in 245 (22.2%) patients. 99% of RA patients had at least one PPF. Patients with MDA/HDA usually coexisted with other PPF. MDA/HDA was significantly correlated with elevated ESR/CRP or high SJC and is not correlated with positive RF/anti-CCP antibody or early bone erosion. Conclusion PPFs are prevalent in RA patients in real-world data. It is inappropriate to guide treatment strategies just based on the presence or absence of PPFs. The categories of PPFs should be simplified and the role of different combinations of PPFs in guiding treatment therapies remains to be explored. References [1]Hu, H., et al., Burden of rheumatoid arthritis from a societal perspective: A prevalence-based study on the cost of this illness for patients in China. International journal of rheumatic diseases, 2018. 21(8): p. 1572-1580. [2]Muñoz-Fernández, S., et al., Use of prognostic factors of rheumatoid arthritis in clinical practice and perception of their predictive capacity before and after exposure to evidence. Rheumatology international, 2018. 38(12): p. 2289-2296. [3]Koga, T., et al., Prognostic Factors Toward Clinically Relevant Radiographic Progression in Patients With Rheumatoid Arthritis in Clinical Practice: A Japanese Multicenter, Prospective Longitudinal Cohort Study for Achieving a Treat-to-Target Strategy. Medicine, 2016. 95(17): p. e3476. [4]Smolen, J.S., et al., EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Annals of the rheumatic diseases, 2020. 79(6): p. 685-699. [5]Fraenkel, L., et al., 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis care &amp; research, 2021. 73(7): p. 924-939. Figure 1. Coexistence of 6 PPFs including positive RF/anti-CCP antibody, elevated ESR/CRP, high SJC, persistent MDA/HDA, failure of two or more csDMARDs, and early bone erosion. Acknowledgements This study was based on the contributions of all colleagues in our department during the outpatient visits over the past decade. Disclosure of Interests None declared